Drug related deaths: learning from the past

It has been proposed that drug related deaths in Scotland, which have been rising since the 1990s, can be attributed to the social, economic and political contexts of the 1980s. Findings from research published today in BMC Public Health add support to this idea and here, lead author of the study Dr Jane Parkinson, discusses the delayed consequences that policies and resulting social conditions have on health and what current drug policy in Scotland can do to support this generation.

2016 saw, for the third consecutive year, the highest number of drug related deaths ever recorded in Scotland. In that year, 867 people lost their lives to drugs. This amounts to a 23% rise on 2015, and more than double the number of deaths of ten years ago (421 in 2006). Rates have continued to rise since the 1990s and they continue to contribute to Scotland’s higher mortality rates overall, relative to the rest of Western Europe.

From the 1980s, less and less of this higher mortality could be explained by association with deprivation alone. It has been proposed that this could be because the social, economic and political contexts of the 1980s created a delayed negative health impact. Indeed, we have found this to be the case for the trends in suicide in Scotland, which also rose in the 1990s.

Those born between around 1960 and 1980 did experience a higher risk of drug-related deaths since the 1990s, and the group at highest risk were males living in the most deprived areas.

We know from the evidence that problem drug use is related to social circumstances, with job loss, poverty, Adverse Childhood Experiences and trauma all being factors. We therefore set out to determine whether Scotland’s trend in drug-related deaths could be explained by a group of people who were young adults of working age in Scotland and had been exposed to the changing social, economic and political contexts of the 1980s.

Our research, published today in BMC Public Health, suggests that this is likely to be the case. Those born between around 1960 and 1980 did experience a higher risk of drug-related deaths since the 1990s (when they were working age), and the group at highest risk were males living in the most deprived areas. The impact of this effect can be seen over the years as this group of people get older, carrying their greater risk of drug-related death with them.

Our findings suggest that the combination of social and economic policies that lead to a rapid rise in income inequality, an increase in unemployment, inadequate housing, poor employment conditions and a negative social context, have serious consequences for health and could account for the higher risk of drug related deaths in this generation of people.

Supporting this group

So, what of the people who were subject to these past policies, who are older now, and who carry an increased risk of drug-related death? It is paramount that they have available to them additional support to take account of the impact that these circumstances have had.

The full impact of the excess mortality in the generation with high drug-related deaths is unlikely to be known for some time. But we know it already represents the deaths of hundreds of people prematurely; half of the current estimated population of 61,500 people in Scotland with drug problems is over 35 years old (considered to be older drug users) and older drug users accounted for almost three quarters (71%) of drug–related deaths in 2016.

As this group of people continues to age, drugs services will need to adapt to their needs.

As this group of people continues to age, drugs services will need to adapt to their needs as co-morbidities from chronic conditions associated with ageing and drug use become more prevalent. It is estimated, for example, that prolonged problematic drug use adds about 15 years’ additional physiological health damage. A recent study also found that older people with drug problems report experiencing stigma, loneliness and isolation. These act as barriers to seeking support and accessing services, preventing individuals from addressing the harms they experience.

There is a need to specifically tailor or adapt, as well as design services to meet the distinct medical, psychological, and social needs such as housing, social security and support services, of this group.

What does this mean for current drugs policy for Scotland?

Crucially, we should learn from the past and inform current and future policy to help prevent a further generation being at greater risk of drug-related deaths in Scotland.

Problem drug use disproportionately affects people who experience socio-economic disadvantage. It is clear that social and economic policy has the potential to either improve, or harm health. On that basis, NHS Health Scotland believes that policy to reduce harm from drug use must take account of the wider things that impact on our health, like housing, work, income and social connectedness – the social determinants of health.

Addressing these wider social inequalities, and reducing poverty, will help play an important role in the prevention of drug misuse and a reduction in associated harms. As the research shows, for many who were exposed to social policy that did not do this, it’s too late for prevention. But what it also shows is that we can take action to reduce harm and prevent more deaths in this group, as well as taking action to ensure the social and economic policies of the future improve health and reduce health inequalities to prevent a repeat of the impact on the generation of the 1980s playing out.

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Dr Jane Parkinson is a Public Health Intelligence Advisor in the Public Health Observatory team at NHS Health Scotland. Her current research is focused on age, period, cohort analysis of health outcomes which contribute to Scotland’s excess mortality and using simulation modelling to estimate the impact of a wide range of policies on population health and health inequalities. She is part of and contributes to the Scottish Public Health Observatory (ScotPHO).